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UNDERGROU TANK PROGRAM OFFICIAL INSPWON REPORT <br /> AN JOAQUIN HEALTH DISTRICT <br /> 1601 E- HAZELTON AVE. <br /> COWY NAME STOCKTON;CA 95205 <br /> PHONE NO. 468-3423 COUNTY #,�� <br /> SITE NAME: 6 INSPECTION DATE/Z <br /> SITE ADDRESS:/,163. �j, , p� CiTY/STATE/7JP <br /> CHANGES SITE/OWNER/PERMIT? Y S N TANK 0� TANK ��- 71ER <br /> o TANK. <br /> FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER UTER COMPUTER <br /> TYPE INSPECTION SITE COMPUTER f NUMBER NUMBER ER NUMBER <br /> �� PER# PER# . PER# <br /> EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK TANK CONTE <br /> Nls � ... <br /> MAJOR MINORmom <br /> A � p <br /> PERMIT TO OPERATE 1 2 <br /> CHANGE IN CONDITIONS TO OPERATE 3 4. <br /> APPROVED CONSTRUCTION 5 6 <br /> WRITTEN MONITORING PROCEDURES 7 8 <br /> APPROVED MONITORING SYSTEM 9 10 <br /> MONITORING SYSTEM 11, 12 <br /> APPROVED MONITOR FREQUENCY 13 14 <br /> MONITORING RECORDS MAINTAINED 15 16 -, <br /> ACCESS CASING SECURED 17 18 <br /> PIPING 19 20 <br /> INVENTORY RECONCILIATION 21 22 { <br /> TANK GAUGING 23 24 . I <br /> APPROVED RESPONSE PLAN 25 26 f[ <br /> UNAUTHORIZED RELEASE OCCURRENCE 27 28 <br /> SAMPLING 29 30 <br /> APPROVED TANK REPAIRS 31 132 _ <br /> UNAUTHORIZED RELEASES REPORTED 33 34 <br /> SAFETY HAZARD 35 36 <br /> CONDITIONS ABATED 37 <br /> TEMPORARY TANK CLOSURERl <br /> rt <br /> REMOVAL OF RESIDUAL 38 39 <br /> FLAMMABLE VAPORS REMOVED 4p <br /> ACCESS LOCATIONS SEALED 41 42 <br /> POWER DISCONNECTED 43 <br /> OWNER/OPERATOR MONITORING 144 45 <br /> PERMANENT TANK CLOSURE " `gyp <br /> REMOVAL OF RESIDUAL MATERIALS 46 47 <br /> PIPING 48 49 <br /> FLAMMABLE VAPORS REMOVED 50 <br /> UNAUTHORIZED RELEASE 51 52 <br /> SAMPLING 53 54 <br /> IMPROPER ABANDONMENT 55 56 <br /> THE MARKED IVMS REPRESENT.VIOLATIONS AND MUST BE CORRECTED AS a+ <br /> SYSTEM STATUS{MUST MARK ONE) FOLLOWS: <br /> MAJOR 57 MINOR NO 59 <br /> VIOL LJ VIOL :❑ VIOL <br /> OFFICE: INSP: RECEIVED BY: <br /> TITLE: j � s PHONE BECK: <br /> HUT-3 ORIGINAL 5/as Q <br />